Preparation and implementation factors in rural healthcare innovation: a mixed methods investigation of a virtual medical officer model of inpatient care in Australia

Background The connections between preparation and implementation factors when introducing virtual models of care in rural inpatient settings are critical for success but remain unexplored. This evaluative study investigated the introduction of a virtual medical officer innovation in three acute wards of a rural health service in Victoria, Australia. To present novel insights, we examined the results using constructs from two implementation frameworks, the Exploration Preparation, Implementation, Sustainment (EPIS), and the Consolidated Framework Implementation Research (CFIR). To synthesise findings, the Implementation Research Logic Model (IRLM) was utilised. Methods The evaluation was process-outcome orientated, undertaken from December 2022 to June 2023, deemed the innovation’s pilot phase. A mixed methods approach was employed, incorporating a review of documents pertaining to the model, an electronic survey specific to nurses at two time points (preparation and implementation), and semi-structured interviews targeting, two groups; Group one, health system stakeholders (nurses, doctors, managers and virtual medical officers) and Group two, patients. Results The document review emphasised the important pre-implementation or exploration factors which were an interdependent platform for subsequent implementation phases, for example having a clear understanding of determinants such as the rural context, the problem and need. Interview findings (n = 77), involving Group one (n = 39); and Group two (n = 38), were categorised into three overarching themes; Facilitators of the telemedicine model, Barriers to the telemedicine model, and Sustaining telemedicine innovation gains for the future of rural healthcare. Critical preparation factors identified were the relational culture of collaboration and partnership during innovation design negotiation, and the importance of organisational and individual leadership. Implementation factors highlighted the effectiveness of the project management approach, and responsive adaptation, such as active feedback loops leading to model adjustment to increase acute ward routine efficiency. Conclusions This study has policy implications for the development of rural medical workforce strategies and the planning of a rural digital healthcare strategy. Our identification of determinants contributing to implementation success, and use of the Implementation Research Logic Model to illustrate connections, would aid decision makers when designing, introducing and adapting rural healthcare innovations to be relevant to context.